Articulating tool and methods of using

ABSTRACT

Disclosed are embodiments of an articulating tool having a head that articulates and is capable of maintaining an angle for drilling or placing a fastener into a bone. The articulating tool includes a housing, an articulating head, a rotatable drive shaft, and a driver tip connected to the distal shaft portion. The articulating tool may be constructed and arranged to move between a first position and a second position, wherein in the first position and the second position the articulating head and the rotatable drive shaft are at different angles with respect to the longitudinal axis of the housing.

CROSS-REFERENCE TO PRIORITY APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/886,474, filed Sep. 20, 2010, which is based upon and claims thebenefit under 35 U.S.C. §119(e) of U.S. Provisional Patent ApplicationSer. No. 61/288,198, filed Dec. 18, 2009.

Each of these priority applications is incorporated herein by referencein its entirety for all purposes.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

The U.S. Government has a paid-up license in this invention and theright in limited circumstances to require the patent owner to licenseothers on reasonable terms as provided for by the terms of contract No.FAR 52.227-11 awarded by Dept. of Defense U.S. Army Medical Research andMaterial Command.

FIELD OF THE INVENTION

The disclosure relates to exemplary embodiments regarding articulatingtools to enable drilling or placement of fasteners. More specifically,exemplary embodiments relate to articulating tools for use in endoscopicsurgery to place fasteners into bone.

BACKGROUND OF THE INVENTION

Rib fractures are common in trauma patients; about 4-10% of traumapatients have rib fractures, of which 10-15% exhibit paradoxical motion.This condition is painful at best, but also reduces respiratoryefficacy; and in extreme cases the fracture endangers the integrity ofthe lungs or heart due to chest wall instability. Chest wall instabilitymay be treated by sedation of the patient or through artificialrespiration, though internal fixation (placement of an osteosyntheticdevice) is often required.

Despite the benefits of internal fixation, existing procedures are quiteinvasive. Due to the invasive nature of the surgery many surgeons opt totreat indications with ventilation and analgesia alone. Titaniumosteosynthetic plates are perhaps the most prevalent fixation method inthe literature. These plates are screwed to the anterior surface of therib at each fracture site.

SUMMARY OF THE INVENTION

In one aspect, embodiments of an articulating tool may include a housinghaving a proximal housing end and a distal housing end, an articulatinghead pivotably connected to the distal housing end by an articulatingjoint, a controller connected to the proximal housing end, a rotatabledrive shaft within the housing having a proximal shaft portion, a medialshaft portion, and a distal shaft portion wherein at least the medialshaft portion is non-rigid, the proximal shaft portion extending throughthe proximal housing end and the medial shaft portion extending throughthe articulating joint, and an operable tip connected to the distalshaft portion. The articulating tool may be constructed and arranged tomove between at least a first position and a second position bymanipulation of the controller, in the first position the articulatinghead is at a first angle with respect to the longitudinal axis of thehousing, and in the second position the longitudinal position of thehousing is altered with respect to the rotatable drive shaft wherein thearticulating head is at a second angle with respect to the longitudinalaxis of the housing. The operable tip may be, but is not limited to, adriver bit or a drill bit.

In other embodiments the articulating tool may include one or more ofthe following features. The articulating tool may include a fastenerretainer connected to the driver tip. The fastener retainer may includea sleeve and a compliant element for retaining a fastener, wherein thecompliant element has an inner diameter smaller than an outer diameterof a fastener head. The articulating tool may include an antagonisticspring connected to the articulating joint. The antagonistic spring maybe made of a superelastic nickel titanium alloy. The articulating toolmay include a motor operably connected to the proximal shaft portion.The articulating tool may include a controller connected to the proximalhousing end of the housing, wherein the controller is configured tochange between the first position and the second position of thearticulating tool. The articulating tool may include a motor operablyconnected to the controller. The articulating tool may articulatebetween an angle of less than or equal to about 60°. The articulatinghead and the housing may have an outer diameter of less than or equal toabout 12 millimeters. The articulating tool may be made of bio-inert andautoclavable materials.

In another aspect, embodiments of a method of using an articulating toolmay include installing an operable tip at the distal end of thearticulating tool, inserting the articulating tool into a body orificein a mammal, manipulating the controller to adjust the articulating headof the articulating tool, and applying torque to the drive shaft of thearticulating tool to engage the operable tip. In one embodiment, theoperable tip may be a driver bit with a fastener. In another embodiment,the operable tip may be a drill bit. In one embodiment, the body orificemay be a natural orifice. In another embodiment, the body orifice may bean incision. In another embodiment, the orifice may be a small incisionin the thorax. In one embodiment, engaging the operable tip may drive afastener into body tissue. In another embodiment, engaging the operabletip may drive a fastener into a rib to secure an osteosynthetic implant.In another embodiment, engaging the operable tip may remove materialsuch as in drilling a hole.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is illustrated in the figures of the accompanying drawingswhich are meant to be exemplary and not limiting, in which likereferences are intended to refer to like or corresponding parts, and inwhich:

FIG. 1 illustrates an embodiment of an articulating tool;

FIG. 2 illustrates the same embodiment of an articulating tool in anarticulated position;

FIG. 3 illustrates a cross-sectional view from one side of the sameembodiment of the articulating tool in the straight position;

FIG. 4 illustrates a cross-sectional view from one side of the sameembodiment of the articulating tool in the articulated position;

FIG. 5 illustrates an exploded view of the same embodiment of the end ofthe articulating tool in the straight position;

FIG. 6 illustrates an exploded view of an embodiment for attaching bitsto the end of the articulating tool;

FIG. 7 illustrates a view of the same embodiment for attaching bits tothe end of the articulating tool;

FIG. 8 illustrates an exploded view of a first embodiment of a fastenerretainer at the end of the articulating tool;

FIG. 9 illustrates a cross-sectional view from one side of the firstembodiment of a fastener retainer at the end of the articulating tool,wherein the fastener is in a fixed position;

FIG. 10 illustrates a cross-sectional view from one side of the firstembodiment of a fastener retainer at the end of the articulating tool,wherein the fastener is in a free position;

FIG. 11 illustrates an exploded view of a second embodiment of afastener retainer at the end of the articulating tool;

FIG. 12 illustrates a cross-sectional view from one side of the secondembodiment of a fastener retainer at the end of the articulating tool,wherein the fastener is in a fixed position;

FIG. 13 illustrates a cross-sectional view from one side of the secondembodiment of a fastener retainer at the end of the articulating tool,wherein the fastener is in a free position; and

FIG. 14 illustrates an embodiment of a method of using an articulatingtool.

DETAILED DESCRIPTION

Described herein are embodiments of articulating tools and methods forconducting thoracoscopic rib fixation. In some embodiments thearticulating tool may enter the thoracic cavity through an incision inthe thorax of a patient and drill or drive a fastener into the proximalsurface of a rib to secure an osteosynthetic implant, for example, butnot limited to, an osteosynthetic plate.

Embodiments of the articulating tool may be used to secureosteosynthetic implants to bone during thoracoscopic surgery. Morespecifically, embodiments of the articulating tool may be used to secureosteosynthetic implants to the posterior cortex of an anterior ribsegment, and/or to the anterior cortex of a posterior rib segment,and/or to the medial surface of a lateral rib segment, through a singleincision, for minimally invasive internal fixation of rib fractures. Theembodiments of the articulating tool may be small enough to be used witha 12 mm trocar sleeve and transmit sufficient torque to fully securefasteners into bone. An articulating joint at the end of thearticulating tool may provide for correct screw alignment at obtuseangles, up to 90° from the articulating tool axis. In some embodimentsthe articulating tool may facilitate obtuse angles up to 60° from thearticulating tool axis. To facilitate obtuse angles up to 60° from thearticulating tool axis, a drive shaft having at least a non-rigidintermediate shaft portion may be used to both transmit torque andactuate the articulating joint. The articulating joint may be actuatedby changing the longitudinal position of the drive shaft with respect tothe rigid housing, or by changing the longitudinal position of the rigidhousing with respect to the drive shaft.

The articulating tool may be used for endoscopic placement of fasteners.The articulating tool may be used for endoscopic placement of fasteners,and may provide for minimally invasive internal fixation of ribfractures that may utilize video-assisted thoracic surgery (VATS).Performing internal rib fixation thoracoscopically with the embodimentsof the articulating tool may provide a number of advantages. The use ofembodiments of the articulating tool may reduce the need for largeincisions and separation of musculature required for existing morbidtechniques. The use of embodiments of the articulating tool may allow afracture constrained on the medial surface to be placed in compressionduring normal respiratory stresses, offering greater mechanicalstability and eliminating stress shielding. The use of embodiments ofthe articulating tool may allow the neurovascular bundle along theinferior edge of each rib to be visible during video-assisted thoracicsurgery (VATS) placement, such that the surgeon may avoid nerve contactand associated post-operative patient pain.

Detailed embodiments of the present invention and methods of use aredisclosed herein, however, it is to be understood that the disclosedembodiments are merely exemplary of the invention, which may be embodiedin various forms. Therefore, specific functional details disclosedherein are not to be interpreted as limiting, but merely as a basis forthe claims and as a representative basis for teaching one skilled in theart to variously employ the present invention.

In one aspect, an embodiment of an articulating tool may include a rigidhousing, an articulating head, a drive shaft, and a driver tip. Thehousing and articulating head may be any shape, length and have anydiameter appropriate for performing surgery. In one embodiment the rigidhousing and articulating head may have an outer diameter at the widestpoint sufficient to allow for the housing and articulating head to fitthrough a trocar sleeve. For example, the housing and articulating headmay have an outer diameter at the widest point of about 5-25 mm, 10-20mm, or 10-15 mm. The housing and articulating head may have across-section of any geometric shape, such as but not limited tocircular, elliptical, oval, square, triangular, rectangular, octagonal,polygonal, etc. The housing and articulating head may be straight,curved, etc. along the longitudinal axis. The housing and articulatinghead may be made of any material, such as but not limited to, metals,plastics, polymers, pliable materials, rigid materials, etc., or anycombination of the foregoing. In one embodiment the housing andarticulating head may be made of a material that may be bio-inert and/orresists high temperatures during autoclave sterilization, such as butnot limited to stainless steel, titanium, bio-alloys, and etc. Inanother embodiment the housing and articulating head may be made of amaterial that is bio-inert and/or disposable.

The articulating head may be connected to the housing by an articulatingjoint. The articulating joint may be any type of joint that may allowthe articulating head to articulate to a desired angle, such as but notlimited to a pivot joint, a sliding joint, a ball and socket joint, ahinge joint, a linkage, a compliant joint, etc. Further, thearticulating joint may include more than one joint, such as a series ofjoints. In one embodiment the articulating joint may be a dual pin hingejoint. More specifically, the hinge pins may be offset slightly from theaxis of the actuating element to avoid a kinematic singularity at thestraight position. The articulating joint may be made of any material,such as but not limited to, metals, plastics, polymers, pliablematerials, rigid materials, etc., or any combination of the foregoing.In one embodiment the articulating joint may be made of a material thatmay be bio-inert and/or resists high temperatures during autoclavesterilization, such as but not limited to stainless steel, titanium,bio-alloys, etc. In another embodiment the articulating joint may bemade of a material that is bio-inert and/or disposable.

The articulating head may articulate to any angle and maintain thatangle. In one embodiment, the articulating head may articulate at anglesfrom about 0° to 90°. In another embodiment the articulating head mayarticulate at angles from about 0° to 60°. It has been determined thatbased on rib geometry an angle of articulation from about 0° to 60° mayallow full access to anterior fractures through a posterior incision.

The length of the articulating head may be directly related to the anglethrough which the articulating head must articulate. A shorter length ofthe articulating head may result in improved maneuverability. The lengthof the articulating head may be any length. The articulating head may bethe same length as the housing, may be longer than the length of thehousing, or may be shorter than the length of the housing. Forendoscopic surgery the length of the articulating head may be about 3 cmto 20 cm. In one embodiment the length of the articulating head may beabout 5 cm to 10 cm. In another embodiment the length of thearticulating head may be about 6 cm.

The drive shaft may extend through the housing, the articulating joint,and the articulating head. The drive shaft may have a dual purpose toboth transmit torque and to actuate the articulating joint. The driveshaft may control the angle of articulation by acting as a tensileelement. In one embodiment the articulation of the articulating head maybe controlled by altering the longitudinal position of the housing, thearticulating head, and/or the articulating joint with respect to thedrive shaft. As the longitudinal position of the drive shaft is alteredwith respect to the housing to increase the tension on the drive shaftthe articulating head may be caused to articulate or increase the angleof articulation. For example, to increase the tension on the drive shaftthe longitudinal position of the drive shaft may be altered to cause thedrive shaft to move away from the articulating end of the articulatingtool while keeping the longitudinal position of the housing stationary.As the longitudinal position of the drive shaft is altered with respectto the housing to decrease the tension on the drive shaft thearticulating head may be caused to relax, or decrease the angle ofarticulation. For example, to decrease the tension on the drive shaftthe longitudinal position of the drive shaft may be altered to cause thedrive shaft to move in the direction of the articulating end of thearticulating tool while keeping the longitudinal position of the housingstationary. Additionally, the drive shaft may be rotated simultaneouslywhile the angle of articulation is adjusted.

The drive shaft may be made of any material in the art, such as but notlimited to metals, plastics, polymers, pliable materials, rigidmaterials, flexible materials, etc., or any combination of theforegoing. In one embodiment the drive shaft may be made of a materialthat may be bio-inert and/or resists high temperatures during autoclavesterilization, such as but not limited to stainless steel, titanium,bio-alloys, etc. In another embodiment the drive shaft may be made of amaterial that is bio-inert and/or disposable. The drive shaft may becompletely flexible, or a combination of flexible portions and rigidportions. The drive shaft may have a flexible portion which extendsthrough the articulating joint to allow for the drive shaft toarticulate with the articulating head. The flexible portion could be anelement known as a flexible shaft. In another embodiment, the flexibleportion of the drive shaft may be composed of an element known as auniversal joint or a series of elements known as universal joints. Inanother embodiment, the flexible portion of the drive shaft may becomposed of a gear set.

The articulating tool may further include a slot or aperture in thehousing and/or the articulating head. The slot may allow for the driveshaft, when articulated, to move off center at high degrees ofarticulation. In one embodiment the portion of the drive shaft thatarticulates is flexible. When the drive shaft is articulated to a highdegree of articulation the shaft may move or deflect a small distancefrom its neutral position or non-actuated position. The slot may allowfor the deflecting portion of the drive shaft to move through the slot,thus allowing for full articulation. Additionally, the slot may becovered by a rigid or flexible mechanism to protect the drive shaft.

The articulating tool may further include an antagonistic element on thearticulating joint to provide an antagonistic force to the articulatingjoint. One purpose of the antagonistic element may be to aid in thestraightening of the angle of articulation to about 0°. Another purposeof the antagonistic element may be to provide for a more controllableangle of articulation. In one embodiment the antagonistic element may bea spring. The spring may be made of any elastic material capable ofproviding an antagonistic force and may be either in compression ortension. In one embodiment the antagonistic spring may be made of asuper elastic material, such as but not limited to, a nickel titaniumalloy. In another embodiment, the antagonistic element may be theflexible portion of the drive shaft.

The articulating tool may further include a controller connected to theproximal end of the housing or drive shaft to control the angle ofarticulation. In one embodiment the controller may control thelongitudinal position of the housing with respect to the drive shaft,thus controlling the angle of articulation. In another embodiment thecontroller may control the longitudinal position of the drive shaft withrespect to the housing, thus controlling the angle of articulation. Thecontroller may be any device capable of altering the longitudinalposition of either the housing or the drive shaft with respect to oneanother, such as but not limited to threaded screws, a gear set, a cam,etc. In one embodiment the controller may be a threaded device that,when turned, alters the longitudinal position of the housing withrespect to the drive shaft, which may be held stationary with respect tothe housing. In another example the controller may be a threaded devicethat when turned alters the longitudinal position of the drive shaftwith respect to the housing, which may be held stationary with respectto the drive shaft. Further, the controller may be made of any material,such as but not limited to, metals, plastics, polymers, pliablematerials, rigid materials, etc., or any combination of the foregoing.In one embodiment the controller may be made of a material that may bebio-inert and/or resists high temperatures during autoclavesterilization, such as but not limited to stainless steel, titanium,bio-alloys, etc. In another embodiment the controller may be made of amaterial that is bio-inert and/or disposable.

The articulating tool may further include at least one power device forsupplying torque to the drive shaft and/or to the controller. Any meansfor supplying power may be used, such as but not limited to manual,electric, and pneumatic drives. In one embodiment power may be suppliedby an electric device such as a DC motor, a DC gear motor, an AC motor,an AC gear motor, etc. The power device used to supply torque to thedrive shaft may be capable of having a peak torque of about 1 N and becapable of operating at about 60 RPM with variable speed. The powerdevice may be capable of operating at, for example, about 0-10,000 RPM,0-1,000 RPM, 0-500 RPM, 0-100 RPM, or 0-60 RPM. In another embodiment, ameans may be provided for manually turning the drive shaft, such as butnot limited to a twist handle or a lever-screw drive.

The articulating tool may further include an operable tip attached tothe drive shaft. The driver tip may be any operable device known in theart such as but not limited to a screwdriver tip, a drill bit, a blade,a socket, an allen tip, a file, etc. In one embodiment the driver tipmay be compatible with screws that are about 2.0 mm or 2.3 mm indiameter. The operable device may be capable of easy replacement. Theoperable tip may be made of any material, such as but not limited to,metals, plastics, polymers, pliable materials, rigid materials, etc., orany combination of the foregoing. In one embodiment the operable tip maybe made of a material that may be bio-inert and/or resists hightemperatures during autoclave sterilization, such as but not limited tostainless steel, titanium, bio-alloys, etc. In another embodiment thedriver tip may be made of a material that is bio-inert and/ordisposable.

The articulating tool may further include a fastener retainer forretaining a fastener, screw, nail, staple, etc. on the driver tip priorto insertion into a bone or other material. This can allow the fastenerto be placed on the tool prior to insertion into the patient. Thefastener retainer may be made of any material, such as but not limitedto, metals, plastics, polymers, pliable materials, rigid materials,etc., or any combination of the foregoing. In one embodiment thefastener retainer may be made of a material that may be bio-inert and/orresists high temperatures during autoclave sterilization, such as butnot limited to stainless steel, titanium, bio-alloys, etc. In anotherembodiment the fastener retainer may be made of a material that isbio-inert and/or disposable. The fastener retainer may have across-section of any geometric shape, such as but not limited tocircular, elliptical, oval, square, triangular, rectangular, octagonal,polygonal, etc. The fastener retainer may be straight, curved, etc.along its longitudinal axis.

The fastener retainer may incorporate any retainer for removablyretaining a faster on the driver tip, such as but not limited tocompliant rings, ball bearings, teeth, locking sleeves, retainingsleeves, magnetic retainers, etc. The retainer may be an activeretainer, which requires the user to release the fastener from theretainer, or a passive means, which does not require the user to releasethe fastener from the retainer. In one embodiment the fastener retainermay include a compliant element, which may be a ring, having an innerdiameter smaller than the outer diameter of the fastener to be retained.The compliant element may retain the fastener and as the fastener fullyseats into bone or other material it pulls itself through the compliantring to a released position. In this manner, the mechanism may bepassive and does not require external actuation. The compliant ring maybe capable of retaining the fastener even in the presence of reasonableradial forces, such as those on the order of about 10 N. Further, thecompliant ring may be capable of retaining the fastener until an axialforce of about 10-25 N is applied. In one embodiment, the compliantelement may be a separate component of an assembled fastener retainer.In another embodiment, the compliant element may be a feature on afastener retainer. In one embodiment the compliant ring may be made of amaterial that may be bio-inert and/or resists high temperatures duringautoclave sterilization. In another embodiment the compliant ring may bemade of a material that is bio-inert and/or disposable.

In another embodiment the articulating tool may include a handle onwhich the motor, housing, power supply, and/or controller may bemounted. The handle may be made of any material, such as but not limitedto, metals, plastics, polymers, pliable materials, rigid materials,etc., or any combination of the foregoing. In one embodiment the handlemay be made of a material that may be bio-inert and/or resists hightemperatures during autoclave sterilization, such as but not limited tostainless steel, titanium, bio-alloys, etc. In another embodiment thehandle may be made of a material that is bio-inert and/or disposable.Additionally, the handle may include a trigger for controlling the powerdistributed to the drive shaft and/or controller for controlling thetorque applied to the drive shaft and/or the angle of articulation. Inone embodiment, the handle may be detachable from the tool and mayfunction as one piece of a modular surgical kit. In another embodiment,the handle may include a means for application of manual torque.

In another embodiment one or more portions of the articulating tool maybe capable of being removed and/or disassembled. For example thehousing, the articulating head, the controller, the driver tip, thedrive shaft, the retention mechanism, etc. may be removed and/ordisassembled from the articulating tool. The portions may then bedisposed of or sterilized/autoclaved for multiple uses.

Turning to FIG. 1, in one embodiment the articulating tool may attach toa separate battery-powered handpiece 101, may include a housing 102, anarticulating head 103, and articulating joint 104. In FIG. 2, thearticulating joint 104 may be adjusted, by manipulating the controller105, to angles between about 0 and 60 degrees. The articulating tool maybe made of a material that may be bio-inert and/or resists hightemperatures during autoclave sterilization. The housing 102 and thearticulating head 103 may have an outer diameter of sufficient size toallow the housing 102 and the articulating head 103 to fit through a 12mm trocar sleeve.

Referencing FIGS. 3, 4, and 5, the rotatable drive shaft includes arigid proximal shaft 106, a non-rigid intermediate shaft 107, and arigid distal shaft 108. In another embodiment, there may be a pluralityof shaft sections, each of which may be rigid or non-rigid. In yetanother embodiment, there may be as few as one or two shaft sections.The drive shaft assembly extends through the controller housing 109, thetool housing 110, the proximal hinge joint 111, and the distal hingejoint 112. The distal rigid shaft 108 is axially and longitudinallyconstrained in the distal hinge joint 112 by a bushing 113. The proximaldrive shaft 106 is axially constrained in the proximal hinge joint 111by bushing 114. The driver tip may be connected to the distal shaft 108by means of a collet nut 115 or other appropriate coupler. The drivertip may be, for example, a screwdriver tip, a drill bit, a blade, asocket, an alien tip, a file, etc.

Referencing FIGS. 3 and 4, the articulating tool may be constructed andarranged to move between a first position and a second position. Tochange between the first and second positions the longitudinal positionof the housing 110 may be altered with respect to the proximal driveshaft 106. As the longitudinal position of the housing 110 is alteredwith respect to the proximal drive shaft 106 the proximal drive shaft106 moves longitudinally through bushing 114 thereby altering the freelength of flexible drive shaft 107. As the free length of flexible driveshaft 107 decreases, the distal hinge joint moves away from the straightposition to allow the flexible drive shaft to assume an arc ofdecreasing radius. Alternatively, as the free length of flexible driveshaft 107 increases, the distal hinge joint moves towards the straightposition to allow the flexible drive shaft to assume an arc ofincreasing radius. Additionally, the drive shaft assembly, comprised ofthe proximal drive shaft 106, the flexible drive shaft 107, and thedistal drive shaft 108, may be rotated simultaneously while the angle ofarticulation is adjusted. In another embodiment, the movement between afirst and second position may be activated by other means such as, butnot limited to, a cable drive system, a set of gears, a linkage or setof linkages, a pushrod or set of pushrods.

Referencing FIGS. 4 and 5, in another embodiment the articulating toolmay include an antagonistic spring 116. The antagonistic spring 116 maybe connected and extending through the proximal hinge joint 111 and thedistal hinge joint 112. As the free length of flexible drive shaft 107increases, the antagonist spring 116 may assist the distal hinge joint112 in moving towards the aligned straight position.

Referencing FIGS. 5 and 6, in another embodiment the articulating toolmay include a slot or aperture in the proximal hinge joint 111 and thedistal hinge joint 112. When the flexible drive shaft 107 assumes an arcof small radius at a high degree of articulation, the flexible driveshaft 107 may move or deflect a small distance from its neutral positionor non-actuated position. The slot may allow for a portion of theflexible drive shaft 107 to deflect through the slot, thus allowing forfull articulation.

Referencing FIGS. 3 and 4, the articulating tool may include acontroller comprised of a controller housing 109, and controller handle117. The proximal drive shaft 106 may be rigidly attached to acontroller drive shaft 118 that is axially and longitudinallyconstrained to the controller housing 109 by bearings 119. The toolhousing 110 may be constrained axially to the controller housing 109 bya sliding fit and longitudinally to the controller handle 109 by pins120, a snap ring, etc. Threads on the controller housing 109 and thecontroller handle 117 may allow the longitudinal position between thecontroller housing 109 and the controller handle 117 to be adjusted byrotation of the controller handle 117 with respect to the controllerhousing 109. In this fashion, the relative longitudinal position of theproximal drive shaft 106 and the tool housing 110 may be adjusted due totheir longitudinal constraint within the controller housing 109 and thecontroller handle 117, respectively. The controller housing 109 and thecontroller drive shaft 118 may be fashioned to attach to a surgicaldrill 101, manual driver handle, etc.

The controller may be capable of changing the articulating tool betweena first and second position. In the first position, as shown in FIGS. 1and 3, the distal hinge joint 112 and the distal drive shaft 108 are ata first angle, about 0°, with respect to the longitudinal axis of thehousing 110. In the second position, as shown in FIGS. 2 and 4, thedistal hinge joint 112 and the distal drive shaft 108 are at a secondangle, θ, to with respect to the longitudinal axis of the housing 110.The angle θ may be anywhere from about 0° to about 60° and may allowfull access a rib fracture site through a single thorax incision.Further, the articulating tool may be infinitely adjustable from about0° to about 60° and may maintain that specific angle. In the firstposition, when the distal hinge joint 112 and the distal drive shaft 108are at a first angle of about 0° with respect to the longitudinal axisof the housing 110, the articulating tool may be capable of fittingthrough a 12 mm trocar sleeve.

Referencing FIGS. 6 and 7, the distal drive shaft 108 may be fitted witha means of interchanging tips 121. The driver tip may be, for example, ascrewdriver tip, a drill bit, a blade, a socket, an alien tip, a file,etc. In one embodiment, the articulating tool incorporates a collet 122and collet nut 115 to allow attaching, detaching, interchanging, orreplacing of a tip.

Referencing FIGS. 8-10, in another embodiment the articulating tool mayaccept a fastener retainer 123. The fastener retainer 123 may hold afastener 124 onto a driver tip 125 by attaching to the distal hingejoint 112. The fastener retainer 123 may include a grooved feature atthe distal end to accept the fastener head 124, where the rim of thegroove has an inner diameter smaller than the largest diameter of thefastener head 124. The fastener retainer 123 may be designed with slotsto decrease the stiffness of the grooved feature and allow the fastener124 to be dislodged by elastic deformation of the fastener retainer. Thefastener retainer 123 may have a proximal groove to allow the fastenerretainer to clip onto a ridge feature on the distal hinge joint 112, asshown in FIG. 9. The proximal groove in retainer 123 may be wide enoughto allow the fastener retainer to slide longitudinally along the distalhinge joint between a first position shown in FIG. 9 and a secondposition shown in FIG. 10. The first position may hold the fastener head124 firmly on the driver bit 125 such that the fastener 124 can besafely delivered to point of installation. The second position isproximal relative to the first position and may release the fastenerhead 124 from the distal groove feature. As the fastener 124 fully seatsin bone or other material, the fastener retainer 125 is forced from thefirst to the second position, thereby releasing the fastener 124 withoutexternal actuation.

Referencing FIGS. 11-13, in another embodiment the articulating tool mayaccept a fastener retainer 126. The fastener retainer 126 may hold afastener 124 onto a driver tip 125 by attaching to the distal hingejoint 112. The fastener retainer 126 may include a groove to receive asoft compliant element 127, at the distal end to accept the fastenerhead 124, where the inner diameter of the compliant element 127 issmaller than the largest diameter of the fastener head 124. Thisarrangement allows the fastener 124 to be dislodged from the elasticelement 127 by applying a reasonable level of longitudinal force. Thefastener retainer 126 may have a proximal groove to allow the fastenerretainer to clip onto a ridge feature on the distal hinge joint 112, asshown in FIG. 9. The proximal groove in retainer 126 may be wide enoughto allow the fastener retainer to slide longitudinally along the distalhinge joint between a first position shown in FIG. 12 and a secondposition shown in FIG. 13. The first position may hold the fastener head124 firmly on the driver bit 125 such that the fastener 124 can besafely delivered to point of installation. The second position isproximal relative to the first position and may release the fastenerhead 124 from the distal groove feature. As the fastener 124 fully seatsin bone or other material, the fastener retainer 126 and compliantelement 127 are forced from the first to the second position, therebyreleasing the fastener 124 without external actuation.

In another aspect a method of using an embodiment of the articulatingtool for thoracoscopic surgery is described. In one embodiment of themethod the articulating tool may be used for minimally invasive internalfixation of rib fractures using video-assisted thoracic surgery (VATS)to place fasteners in osteosynthetic implants. VATS is awell-established procedure for pulmonary resection, lung volumereduction, lung biopsy, and pericardial resection. By selectivelyventilating one lung with a dual lumen endotracheal tube, much of thepleural cavity may become accessible. An embodiment of the articulatingtool may be an appropriate device for fastener delivery using VATSfixation of rib fractures. Further, the embodiments of the articulatingtool described herein may be articulated within the thoracic cavity toallow placement of fasteners normal to the local surface of a curvedrib.

Referencing FIG. 14, an embodiment of a method of using the articulatingtool to perform minimally invasive internal fixation of rib fractures isillustrated. While FIG. 14 illustrates a number of steps, any step orsteps may be added or removed, and the steps may be performed in anyorder. The method described is the preferred embodiment, however themethod may be performed in alternative body cavities, may be performedwith any operable tip known to the art, or may be performed to secureany device known to the art to body tissue.

The method of minimally invasive rib fixation using an embodiment of thearticulating tool may include intubating the patient with a dual lumenendotracheal tube and selectively deflating one lung 128. The method mayinclude making a series of small incision in the thorax 129 such thattrocar sleeves can be placed 130, allowing the insertion of a camera131. Under the guidance of the camera, an osteosynthetic implant may beinserted and contoured to the rib 132 using tools known to the art. Anembodiment of the articulating tool with a drill bit attached as theoperable bit may be inserted through a trocar sleeve 133. Under theguidance of the camera, the embodiment of the articulating tool may beadjusted to the appropriate angle for accessing a particular operatingsite 134.

The method may include adjusting the placement of the osteosyntheticimplant for use as a drilling template 135 using tools known to the artand drilling pilot holes 135 by applying torque to the articulatingtool. After performing a task, the articulating tool may be straightenedby manipulating its controller 136 and withdrawn from the thoraciccavity 137.

The method may further include utilizing a driver bit as the operabletip with a fastener 138. The fastener may be held in place with afastener retainer 138. The articulating tool may be inserted through atrocar sleeve 139. Under the guidance of the camera, the embodiment ofthe articulating tool may be adjusted to the appropriate angle foraccessing a particular operating site 140. Torque may be applied to thearticulating tool to drive the fastener into the rib 141, at which timethe fastener retainer may release the fastener. The fastener may securean osteosynthetic implant to the rib. After performing a task, thearticulating tool may be straightened by manipulating its controller 142and withdrawn from the thoracic cavity 143. Steps 138 through 143 may berepeated several times to deliver multiple fasteners.

While the invention has been described and illustrated in connectionwith preferred embodiments for use in surgery, many variations andmodifications will be evident to those skilled in the art and may bemade without departing from the spirit and scope of the invention. Theinvention is thus not to be limited to the precise details ofmethodology or construction set forth above as such variations andmodification are intended to be included within the scope of theinvention.

We claim:
 1. A method of fastener installation, the method comprising:positioning a head of an articulating tool in a thoracic cavity underthoracoscopic guidance, the head holding a fastener, the thoracic cavitybeing surrounded by a chest wall that includes a rib bone; and drivingthe fastener into an inner side of the rib bone from the thoracic cavitywith the articulating tool.
 2. The method of claim 1, wherein the stepof driving the fastener includes a step of affixing an osteosyntheticimplant to the rib bone with the fastener.
 3. The method of claim 1,wherein the osteosynthetic implant is an osteosynthetic plate.
 4. Themethod of claim 2, further comprising a step of inserting theosteosynthetic implant into the thoracic cavity under thoracoscopicguidance.
 5. The method of claim 4, further comprising a step ofcontouring the osteosynthetic implant to the rib bone after the step ofinserting the osteosynthetic implant.
 6. The method of claim 1, furthercomprising a step of drilling a hole in the rib bone from the thoraciccavity by application of torque to a drive shaft of the articulatingtool.
 7. The method of claim 6, wherein the step of drilling a hole isperformed with a drill bit operatively connected to the drive shaft ofthe articulating tool, further comprising a step of replacing the drillbit with the fastener before the step of driving the fastener.
 8. Themethod of claim 1, further comprising a step of introducing the head ofthe articulating tool into the thoracic cavity through an incision inthe thorax.
 9. The method of claim 1, wherein the step of positioning ahead of an articulating tool includes a step of pivoting the head aboutan axis transverse to the articulating tool, and wherein the transverseaxis is defined by a pivotable joint that connects the head to adiscrete housing of the articulating tool.
 10. The method of claim 1,wherein the fastener is selected from the group consisting of a screw, anail, and a staple.
 11. The method of claim 1, wherein the step ofdriving the fastener includes a step of rotationally driving thefastener into the rib bone by application of torque to a drive shaft ofthe articulating tool.
 12. A method of rib fixation, the methodcomprising: positioning a head of an articulating tool in a thoraciccavity under thoracoscopic guidance, the head holding a fastener, thethoracic cavity being surrounded by a chest wall that includes a ribbone; and affixing an osteosynthetic implant to a rib bone by drivingthe fastener into an inner side of the rib bone from the thoracic cavitywith the articulating tool.
 13. The method of claim 12, wherein theosteosynthetic implant is an osteosynthetic plate.
 14. The method ofclaim 12, further comprising a step of inserting the osteosyntheticimplant into the thoracic cavity under thoracoscopic guidance.
 15. Themethod of claim 14, further comprising a step of contouring theosteosynthetic implant to the rib bone after the step of inserting theosteosynthetic implant.
 16. The method of claim 12, further comprising astep of drilling a hole in the rib bone from the thoracic cavity byapplication of torque to a drive shaft of the articulating tool.
 17. Themethod of claim 12, further comprising a step of introducing the head ofthe articulating tool into the thoracic cavity through an incision inthe thorax.
 18. The method of claim 12, wherein the step of positioninga head of an articulating tool includes a step of pivoting the headabout an axis transverse to the articulating tool, and wherein thetransverse axis is defined by a pivotable joint that connects the headto a discrete housing of the articulating tool.
 19. The method of claim12, wherein the fastener is selected from the group consisting of ascrew, a nail, and a staple.
 20. The method of claim 12, wherein thestep of driving includes a step of rotationally driving the fastenerinto the rib bone by application of torque to a drive shaft of thearticulating tool.